Q and A With Marc Probst

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Intermountain Health Care

The CIO of Intermountain Health Care describes how they are fulfilling theirobjective of a unified longitudinal medical record.

Healthcare Technology: Can you tell us a little bit about Intermountain Health Care (IHC) and your work there?

Marc Probst: IHC is 22 hospitals, about a hundred clinics, with an annual revenue of about $3 billion a year.We have approximately 500,000 members in the health plan, and provide administrative services for about another 500,000 members.We have a very successful physician division, which includes about 600 physicians. All of our hospitals are in the state of Utah except one small hospital in the southern part of Idaho. Our mission is to provide the highest quality care at the lowest appropriate cost in the Intermountain region.We’re currently building three new hospitals over the next three years. I am the CIO.

HCT: We are trying to get an understanding of what’s happening with local health information infrastructure initiatives as they implement EHR systems. Can you give me some background on your initiative and how it evolved?

MP: About 30 years ago, IHC, which at the time was called LDS Hospitals, built a system called HELP that was conceived by a gentleman named Homer Warner. That was probably the first clinical information system and was primarily a clinical decision support tool. That system, although it has evolved over the years, is still in use at LDS Hospital and a couple of our other hospitals. It’s relatively old, but still useful technology. It’s based on an episodic medical record.

About eight years ago, Intermountain Health Care set out on an endeavor to create a longitudinal medical record which we call HELP2.We continue to develop HELP2. Initially we focused on developing the infrastructure for the longitudinal record, including the clinical data repository, the health data dictionary, the decision support products and all the integration components. With this infrastructure in place, IHC developed an ambulatory medical record system that’s used by nearly all of our employed physicians, and components of it by nearly 2,000 physicians in Utah.

Currently our primary inpatient system is the original HELP system. IHC has made a couple of attempts at developing the inpatient applications, but these were not fully successful. It was made clear to me upon arriving at IHC that a major assignment is to complete the inpatient components and implement them across all of our facilities. Last year we initiated a search to see what was available in the market, and determined that the currently available vendor offerings just didn’t have all the things we needed. So we decided as an organization that we’d complete the build.We specified the budget and received approval to proceed. However, as you can imagine, this is a very large and significantly risky project.

In an effort to offset some of the risk as well as the costs,we completed a detailed review of potential partners and have decided to partner with General Electric (GE) to complete the inpatient components of our electronic health record (EHR).We will be building the system here in Salt Lake with GE.

We’re also very involved in an organization called UHIN. UHIN started as a Utah claims clearing facility and is now expanding into the clinical side to become more of a regional health information organization. We’re very involved in what UHIN is doing, as we see significant benefit for our community and what we’re trying to do with clinical transactions.

HCT: What are some of the objectives and who are some of the other participants?

MP: The objective is to get a unified longitudinal medical record and standard systems to all of our hospitals. The goal is to get it done within five years. I think if you talk to GE, they want to do it quicker, but five years is pretty realistic. The other participants are GE, our providers and our business partners; we don’t have any other partners beyond that. We purchased GE’s pharmacy system. We also purchased ORMIS; we have MySIS in our labs. Our ancillary strategy is to buy best of breed and then integrate this into the core clinical system we are developing.

HCT: What do you think are some of the challenges or barriers? Why hasn’t it happened yet?

MP: Certainly some of the barriers are technical and we’re struggling through many, though I think we’ve mostly succeeded on these issues.We have approximately 5 million patients with records in our clinical data repository, which is the longitudinal record.We have 2 million active members at any given time and have complete redundancy. Obviously we’ve learned over time we need to have redundancy just to have the kind of reliability that we need in our system. Architecture has been a huge struggle and was a major reason for not selecting a vendor product. Although we have defined a very good architecture for the system, we still struggle with decisions such as whether to go with a thin client or a thick client, what the GUI (graphical user interface) should look like and usability.

So technology is certainly a big piece of it. User commitment also is a significant challenge. The leadership of IHC (particularly Chief Nursing Officer Nancy Nowak and Chief Medical Officer Dr. Brent Wallace) has been key to gaining the engagement of clinical practitioners. This engagement is a true key to our ability to succeed.

Other challenges include prioritizing components for development, the balance between research and development, training (we have about 25,000 users across a large geography) and balancing tactical needs while remaining focused on completing this system.We have a lot of challenges, but IHC is up to it.

HCT: What about doctors? Do you think that physicians are technophobes?

MP: Well some doctors are certainly technophobes. Others are techno-addicts. IHC is really blessed to have a strong core of clinicians (doctors, nurses, pharmacists, etc.) who are interested in and will spend the time to help define the requirements and test the systems we build. Additionally, IHC has a renowned core of medical informaticists that help push the envelope as to how systems can be better used in healthcare. I am much less concerned about technophobia than I am about our ability to get these systems developed and deployed.

HCT: I think you said it would take about five years; do you think you’ll be there then?

MP: I think we’ll start deploying some applications as soon as next year.We won’t likely be fully deployed with the complete solutions we are striving to have, for five years. If we are complete before that, it would be a marvelous event. Right now we just need to focus on defining requirements, writing use cases, organizing teams and deploying 240+ developers on this project.